Osteoporosis screening guidelines in the United States recommend a bone density test (a DEXA scan) for all women aged 65 and older, and for younger postmenopausal women whose risk factors put them at increased fracture risk. For men, major bone-health organizations advise testing from age 70, or from age 50 when risk factors are present, although the evidence for routine screening in men is less settled. The goal is simple: find weak bones before the first fracture, not after it.
Below I walk through who should be screened, how the test works, how to read the results, and what happens next.
Why Screening Matters
Osteoporosis is a skeletal disorder in which bone mass falls and the internal structure of bone weakens, so bones break with minor falls or even everyday strain. It is often called a silent disease because there are no symptoms until a fracture happens.
The most common sites are the spine, hip and wrist. Hip fractures in particular can end independent living for many older adults. Some people notice warning signs such as height loss or a stooped posture, which usually reflect vertebral compression fractures that have already occurred. Screening exists to catch the disease earlier than that.
Who Should Be Screened?
Different organizations word their advice slightly differently, but they converge on the same core groups.
| Group | General recommendation |
|---|---|
| Women 65 and older | Screen with bone density testing, regardless of risk factors |
| Postmenopausal women under 65 | Screen if a risk assessment shows increased fracture risk |
| Men 70 and older | Many bone-health societies advise testing; evidence for routine screening is weaker than in women |
| Men 50–69 | Consider testing if risk factors are present |
| Any adult with a fragility fracture after age 50 | Evaluate for osteoporosis |
| Adults on long-term glucocorticoids or with bone-weakening conditions | Evaluate, often earlier than age-based thresholds |
In the US, the screening visit is coded as ICD-10 Z13.820 for osteoporosis screening, which matters for clinicians handling documentation and coverage.
Risk factors that prompt earlier testing
- Early menopause or low estrogen, or low testosterone in men
- Low body weight
- A parent who broke a hip
- Current smoking or heavy alcohol use
- Long-term use of glucocorticoids (such as prednisone), aromatase inhibitors, androgen deprivation therapy or some anticonvulsants
- Rheumatoid arthritis, hyperthyroidism, hyperparathyroidism, celiac disease or other malabsorption
- Low calcium or vitamin D intake and a sedentary lifestyle
How Screening Is Done
DEXA scan
The standard test is dual-energy X-ray absorptiometry (DEXA or DXA). It measures bone mineral density (BMD) at the hip and lumbar spine, and sometimes the forearm. It is quick, painless and uses a very low radiation dose, much less than a standard chest X-ray. You lie on a padded table for a few minutes while the scanner passes over you.
Fracture risk tools
Bone density is only part of the story. Tools such as FRAX combine age, sex, body mass, prior fracture, family history, smoking, alcohol, steroid use and other factors (with or without the BMD result) to estimate a person’s 10-year probability of a hip fracture and of a major osteoporotic fracture. For younger postmenopausal women, a risk tool helps decide whether a DEXA scan is warranted in the first place.
Vertebral fracture assessment
Because many spine fractures cause little pain, some clinics add a low-dose lateral spine image during the DEXA to look for hidden vertebral fractures. Finding one can change the diagnosis and treatment plan on its own.
Reading Your Results
Your DEXA report gives a T-score, which compares your bone density with that of a healthy young adult. The World Health Organization categories are the ones used almost everywhere:
| T-score | Category |
|---|---|
| -1.0 or higher | Normal bone density |
| Between -1.0 and -2.5 | Low bone mass (osteopenia) |
| -2.5 or lower | Osteoporosis |
| -2.5 or lower plus a fragility fracture | Severe (established) osteoporosis |
A Z-score, which compares you with people of your own age and sex, is used instead for premenopausal women, men under 50 and children. A low Z-score suggests something other than normal aging may be affecting bone and usually prompts a search for a secondary cause.
Importantly, osteoporosis can also be diagnosed clinically without a T-score of -2.5: a hip or spine fracture from a minor fall in an older adult is enough.
What Happens After Screening
If results are normal, the next scan is usually years away, with shorter intervals for people whose scores sit close to the osteoporosis threshold or whose risk factors change. If results show osteopenia, the FRAX score helps decide whether medicine is worthwhile or lifestyle measures alone are enough.
When treatment is needed, first-line options are usually bisphosphonates such as alendronate, risedronate or yearly zoledronic acid. Alternatives include denosumab, and for those at very high risk, bone-building agents such as teriparatide, abaloparatide or romosozumab. Treatment decisions sit alongside the basics: adequate calcium and vitamin D, weight-bearing and balance exercise, stopping smoking, limiting alcohol and preventing falls. For people already living with the condition, our articles on osteoporosis pain treatment and managing osteoporosis and hip pain at night cover the day-to-day side.
Follow-up DEXA scans on the same machine, typically one to two years after starting treatment, help confirm the medicine is working.
When to See a Doctor
Ask about a bone density test if you are a woman aged 65 or over, a postmenopausal woman with risk factors, a man over 70, or anyone over 50 who has broken a bone in a minor fall. See your doctor promptly if you notice height loss of more than an inch or two, a new stoop, or sudden back pain after lifting or bending, which can signal a spinal fracture.
Frequently Asked Questions
At what age should a woman get her first bone density test?
At 65 at the latest. Postmenopausal women younger than 65 should be tested earlier if a risk assessment shows increased fracture risk, for example because of early menopause, low body weight or steroid use.
Do men need osteoporosis screening?
Men do get osteoporosis, and hip fractures in men carry serious consequences. Many bone-health societies recommend testing men from age 70, or from 50 with risk factors, though evidence-based screening bodies consider the data for routine screening in men less conclusive.
Is a DEXA scan safe?
Yes. The radiation dose is very low, lower than a standard chest X-ray, and the test is painless. Tell the technician if you might be pregnant or recently had a barium or contrast study, which can affect the reading.
How often should I repeat a bone density scan?
It depends on your result and risk. People with normal scores may not need another for many years, while those near the osteoporosis threshold or on treatment are usually rescanned every one to two years.
Key Takeaways
- Screen all women 65 and older, and younger postmenopausal women at increased risk.
- Men are generally tested from 70, or from 50 with risk factors.
- DEXA measures bone density; a T-score of -2.5 or lower means osteoporosis.
- FRAX and similar tools add clinical risk factors to guide treatment decisions.
- Screening is only useful if it leads to action: medication where needed, plus calcium, vitamin D, exercise and fall prevention.
